Childhood Apraxia of
Speech
Since I have been at Rehabilitation Specialists, I have
worked with many children with the diagnosis of Childhood Apraxia of Speech (CAS).
However, I have been hesitant to write a blog post about this disorder.
There is so much misinformation on the web as a whole; yet, there is so much
good information on www.apraxia-kids.org
that I felt like I did not want to be redundant. However, When I was a student
at Duquesne University, I was fascinated by this motor speech disorder and
actively asked to work with individuals with this diagnosis. I believe this is
why for my last rotation of clinicals, I was sent here to work with Kathy
Helfrich-Miller. Kathy retired this January and asked Julie and I to take over
her life’s work. However, she has not completely left Rehab Specialists-- she
still mentors us in many ways! So, as she taught me everything I know about
apraxia, I asked her to be the guest expert for this installment of “5
Questions With…” series.
Kathy received her doctorate degree at the young age of 25
and decided to open this private practice just as she was entering her early
motherhood years. She had a special interest in how young children learn
language and did her dissertation on this subject relating to how primary
caregivers speak to their children. Later, she did research on Childhood
Apraxia of Speech; specifically, she did work on a technique called Melodic Intonation
Therapy, which mixes musical notes with sentences to make the intonation of
sentences, and in this case the sequencing of words, more naturalistic. It was
this research that made Kathy a name in the word of CAS. She went on to teach
some of the experts of CAS in this field and has taught me everything I know
today. Without further hesitation, Kathy will now teach our readers a little
about CAS.
What exactly is
Childhood Apraxia of Speech?
Childhood apraxia of speech has been called by many names
over the years. ASHA officially designated the name Childhood Apraxia of Speech
(CAS) as:
Childhood apraxia of speech (CAS) is a neurological
childhood (pediatric) speech sound disorder in which the precision and
consistency of movements underlying speech are impaired in the absence of
neuromuscular deficits (e.g., abnormal reflexes, abnormal tone). CAS may occur
as a result of known neurological impairment, in association with complex
neurobehavioral disorders of known or unknown origin, or as an idiopathic
neurogenic speech sound disorder. The core impairment in planning and/or
programming spatiotemporal parameters of movement sequences results in errors
in speech sound production and prosody.
My working definition is little simpler and involves:
n Child
has a reduced repertoire of sounds and poor ability to program sounds and sound
movements.
n Characterized
primarily by the impaired ability to program, combine and sequence the elements
of speech.
n Considered
to be a neurogenic sensorimotor speech disorder. Has a neurological basis of
unknown origin.
How is CAS different
than a normal articulation disorder?
The main difference is in the inability to program “movement
patterns”. Let me explain what that means. In a child with an articulation or
phonological disorder, the child has difficulty with specific sounds, for
example, the production of /k, g, p, b, m/ or with sounds in a particular
position (final consonant deletion). However, when they learn to produce the
sounds, they don’t have any difficulty combining that sound with other sounds
and with vowels. For example, they can put together (sequence) the sound with
another vowel, (bye, my, tie) without difficulty and then go on to combine the
sound with other ones (baby, cookie,). The child with CAS cannot make the
movement pattern to combine the sounds. They can say /b/ and they can say /a/
but they cannot sequence the two sounds together to form /ba/. They, when they
try to put additional sounds together, they can’t do that either (baby might
become maybe, or bamay). Each time they try to say the word, the sequence might
be different.
What are some of the
things you look for to make a diagnosis of CAS?
Childhood
Apraxia of Speech is defined by a symptom cluster.
n Not
all symptoms must be present; no one characteristic or symptom must
be present and the typically reported symptoms are not exclusive to developmental
apraxia of speech.
n Compounding
the problem is the observation that children change over time.
n This
condition unfolds and changes as the child grows and develops.
The symptom cluster includes the
following:
Delayed and deviant speech development
Extremely poor imitative skills
Difficulty maintaining the same motor-speech pattern
twice
Significant sequencing and combining problems
Errors increase as words increase in length
Movement Patterns impair the production of syllable
shapes
Interrelationship with the
length and form of expressive language is apparent. This is because the
MOVEMENT pattern is not the same in connected speech. Ball, Blue Ball Red Ball The ball is big. Mary found a ball.
The movement pattern for the /b/
is different in each of these cases because the “syllable shape” is different.
May have slowed rate, even stress, even spacing
Vowel Misarticulations
Voiced and voiceless sound confusions
What are some of the
treatment techniques you use for a child with CAS?
I use a variety of techniques depending on the age,
attention span, and ability of the child. I might focus on the development of
basic expressive language prior to focusing on specific sounds.
I use rhythm, melody, intonation to improve sequencing.
Melodic Intonation is a favorite at all ages but is usually adapted at an early
age to include tapping or whole-body gestures instead of signing. Visual
representation of sounds is important. I will teach individual sounds but
quickly move on to sequencing the sounds. Work on syllable structure. A Multi-sensory—visual, tactile, auditory approach
works well. Encourage rate control, rhythm, intonation, Touch cues, Movement, Forward
and backward chaining, and Chunking. Increase intensity of therapy but beware
of burnout as these children often need a prolonged period of therapy.
Principles of motor learning help:
Practice makes Perfect
Preparation is beneficial
Explanations are helpful
How we distribute practice matters
Rate influences learning
Feedback is important
What is the most
important thing you think a parent of a child with CAS should know about their
child’s diagnosis?
No two children are alike. There are many techniques that
work. Therapy should be tailored to your child. The goal is for your child to
talk although we might use some nonverbal techniques such as communication
boards, signing or AAC devices to help your child get there!
Let your therapist guide you with how to help your child
learn. Stay off the internet, except for
well researched sites. Your therapist can guide you to some of the best
sites such as www.Apraxia-Kids.org.
If you suspect your child has CAS, please reach out to a local SLP for a full evaluation. We can be reached here at Rehab Specialists at the number or email in the description. Until next time!
Kathleen
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